鼻内镜术后鼻出血相关因素分析

Potential risk factors of excessive epistaxis after endoscopic endonasal surgery

目的:探讨鼻内镜术后鼻出血的相关危险因素及其处理措施。方法:回顾性分析2011-2012年我科完成的641例鼻内镜手术的临床资料,并对围手术期可能与术后出血相关的因素进行单因素及非条件Logistic多因素分析。结果:鼻内镜术后出血的发生率为8.4%,单因素分析结果显示既往鼻内镜手术史、高血压病史以及长期服用非甾体抗炎药(NSAIDs)3个因素与鼻内镜术后出血的发生显著相关,多因素分析结果显示除了上述3个因素外,鼻中隔黏膜下矫正术及术前激素治疗亦为影响鼻内镜术后出血发生的独立因素(OR值分别为15.673、2.443、5.099、16.197和0.269)。结论:既往鼻内镜手术史,鼻中隔黏膜下矫正术、高血压病史、长期服用NSAIDs以及术前激素治疗是影响鼻内镜术后出血发生的独立因素,其中,术前激素治疗,平稳控制高血压病患者的血压以及停用NSAIDs 2周或以上可在一定程度上减少鼻内镜术后出血的风险,临床医师术前应根据患者的实际情况采取相应的措施以减少或避免术后出血的发生。

ObjectiveTo investigate the potential risk factors and management of excessive epistaxis after en-doscopic endonasal surgery（EES）. Method：Six hundred and forty-one patients who underwent EES in our hospitalfrom December 2011 to December 2012 were reviewed retrospectively. Factors which potentially affect the inci-dence of excessive epistaxis after EES were analyzed with univariate and multivariate logistic regression model.Result：The incidence rate of excessive epistaxis after EES was 8.4% in our study. Multivariate logistic regressionanalysis revealed that history of previous EES, along with other four factors, correlated significantly with the oc-currence of excessive epistaxis after EES. Conclusions：Previous EES, along with other three factors, may increasethe chance of excessive epistaxis after EES, while pre-operative corticosteroid therapy may reduce the risk to someextent.